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Neuman T, Corrado R, Banaag A, Koehlmoos TP. Utilization of antiobesity medications within the Military Health System. Obesity (Silver Spring) 2024. [PMID: 39089987 DOI: 10.1002/oby.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS. METHODS A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022. RESULTS The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs. CONCLUSIONS Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.
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Affiliation(s)
- Taylor Neuman
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Richele Corrado
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amanda Banaag
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Anazco D, Acosta A, Cathcart-Rake EJ, D'Andre SD, Hurtado MD. Weight-centric prevention of cancer. OBESITY PILLARS 2024; 10:100106. [PMID: 38495815 PMCID: PMC10943063 DOI: 10.1016/j.obpill.2024.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Background The link between excess adiposity and carcinogenesis has been well established for multiple malignancies, and cancer is one of the main contributors to obesity-related mortality. The potential role of different weight-loss interventions on cancer risk modification has been assessed, however, its clinical implications remain to be determined. In this clinical review, we present the data assessing the effect of weight loss interventions on cancer risk. Methods In this clinical review, we conducted a comprehensive search of relevant literature using MEDLINE, Embase, Web of Science, and Google Scholar databases for relevant studies from inception to January 20, 2024. In this clinical review, we present systematic reviews and meta-analysis, randomized clinical trials, and prospective and retrospective observational studies that address the effect of different treatment modalities for obesity in cancer risk. In addition, we incorporate the opinions from experts in the field of obesity medicine and oncology regarding the potential of weight loss as a preventative intervention for cancer. Results Intentional weight loss achieved through different modalities has been associated with a reduced cancer incidence. To date, the effect of weight loss on the postmenopausal women population has been more widely studied, with multiple reports indicating a protective effect of weight loss on hormone-dependent malignancies. The effect of bariatric interventions as a protective intervention for cancer has been studied extensively, showing a significant reduction in cancer incidence and mortality, however, data for the effect of bariatric surgery on certain specific types of cancer is conflicting or limited. Conclusion Medical nutrition therapy, exercise, antiobesity medication, and bariatric interventions, might lead to a reduction in cancer risk through weight loss-dependent and independent factors. Further evidence is needed to better determine which population might benefit the most, and the amount of weight loss required to provide a clinically significant preventative effect.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Maria D. Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
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Sher T, McGee M, DuCoin C, Sujka J, Docimo S. Evaluating the use of adjuvant and neoadjuvant terminology in bariatric surgery: a scoping review. J Gastrointest Surg 2024; 28:966-974. [PMID: 38523037 DOI: 10.1016/j.gassur.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Weight regain and inadequate weight loss are common after bariatric surgery. Literature is emerging regarding the use of pharmacotherapy with bariatric surgery as a potential solution to these adverse effects. Pharmacotherapy may be used before (neoadjuvant) or after (adjuvant) bariatric surgery, although this terminology has not been standardized. As a rapidly growing area of research, there is opportunity to standardize terminology for future ease of research, data synthesis, and communication. This review aimed to comprehensively evaluate the use of the terms "adjuvant" and "neoadjuvant" to describe pharmacotherapy used in combination with bariatric surgery and propose standardized terminology for future research. METHODS Literature search was conducted systematically and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were published after 1999; were randomized controlled trials, prospective/retrospective cohort studies, or case series; and used human subjects that were adults at least 18 years of age. The use of the terms "neoadjuvant" and "adjuvant" was analyzed over time. RESULTS Thirty-four publications were included. Thirty-two (94.1%) studied the use of adjuvant pharmacotherapy after bariatric surgery. Four (11.8%) studied the use of pharmacotherapy before bariatric surgery, and 1 used the term "neoadjuvant" to describe medications used before bariatric surgery. Eight publications used the term "adjuvant" to describe medications used after bariatric surgery. CONCLUSION Standardized terminology is needed to ease future understanding, evidence synthesis, and dissemination of work. We propose that the terms "neoadjuvant" and "adjuvant" become the standard terminology to describe pharmacotherapy use before and after bariatric surgery, respectively.
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Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
| | - Michelle McGee
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgery, University of South Florida, Tampa, Florida, United States
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Ruiz PLD, Karlstad Ø, Nøkleby K, Slåtsve K, Gulseth HL, Meyer HE, Sveen KA, Qvigstad E, Furu K. Pharmacological treatment of obesity in adults in Norway 2004-2022. Diabetes Obes Metab 2024; 26:2102-2110. [PMID: 38419410 DOI: 10.1111/dom.15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
AIMS To describe trends in the use of anti-obesity drugs in Norway during the period 2004-2022. MATERIALS AND METHODS We assessed the annual utilization of any available drug indicated for obesity recorded in the nationwide Norwegian Prescribed Drug Register for adults (age 18-79 years) from 1 January 2004 to 31 December 2022. Prevalence was stratified by sex and age group (18-29 years and 10-year age groups thereafter). Additional analyses were performed in individuals initiating treatment with an anti-obesity drug and on the cost of the anti-obesity drugs since 2017. RESULTS The prevalence of anti-obesity drug use decreased from 2009, when sibutramine and rimonabant were withdrawn from the market, and increased again after the approval of bupropion-naltrexone in 2017 and liraglutide in 2018. The use of the peripheral-acting anti-obesity drug orlistat decreased from 2004. In 2022, 1.04% of the adult Norwegian population (72.8% women) filled at least one prescription of bupropion-naltrexone, 0.91% used liraglutide (Saxenda; 74.2% women), and semaglutide without reimbursement was used by 0.68% (76.7% women). The prevalence increased with age, peaking in the age group 50 to 59 years, and decreased in older age groups. From 2017 to 2022, 2.8% of the adult residents initiated treatment with an anti-obesity drug. The total sale of those drugs increased from 1.1 million euros in 2017 to 91.8 million euros in 2022. CONCLUSIONS The use of anti-obesity drugs in Norway has increased substantially in recent years, especially among women aged 40 to 59 years. Changes in availability and reimbursement have influenced the use of these drugs in recent years.
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Affiliation(s)
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Kjersti Nøkleby
- Department of General Practice, University of Oslo, Oslo, Norway
| | | | - Hanne L Gulseth
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Kari Anne Sveen
- Department of Endocrinology, Preventive Medicine and Morbid Obesity, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Preventive Medicine and Morbid Obesity, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab 2024; 26:1687-1696. [PMID: 38287140 PMCID: PMC11001528 DOI: 10.1111/dom.15473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 01/31/2024]
Abstract
AIM To characterize factors associated with the receipt of anti-obesity medication (AOM) prescription and fill. MATERIALS AND METHODS This retrospective cohort study used electronic health records from 1 January 2015 to 30 June 2023, in a large health system in Ohio and Florida. Adults with a body mass index ≥30 kg/m2 who attended ≥1 weight-management programme or had an initial AOM prescription between 1 July 2015 and 31 December 2022, were included. The main measures were a prescription for an AOM (naltrexone-bupropion, orlistat, phentermine-topiramate, liraglutide 3.0 mg and semaglutide 2.4 mg) and an AOM fill during the study follow-up. RESULTS We identified 50 678 adults, with a mean body mass index of 38 ± 8 kg/m2 and follow-up of 4.7 ± 2.4 years. Only 8.0% of the cohort had AOM prescriptions and 4.4% had filled prescriptions. In the multivariable analyses, being a man, Black, Hispanic and other race/ethnicity (vs. White), Medicaid, traditional Medicare, Medicare Advantage, self-pay and other insurance types (vs. private insurance) and fourth quartile of the area deprivation index (vs. first quartile) were associated with lower odds of a new prescription. Hispanic ethnicity, being a man, Medicaid, traditional Medicare and Medicare Advantage insurance types, liraglutide and orlistat (vs. naltrexone-buproprion) were associated with lower odds of AOM fill, while phentermine-topiramate was associated with higher odds. Among privately insured individuals, the insurance carrier was associated with both the odds of AOM prescription and fill. CONCLUSIONS Significant disparities exist in access to AOM both at the prescribing stage and getting the prescription filled based on patient characteristics and insurance type.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Elizabeth R. Pfoh
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Rebecca Schulte
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Erin Sullivan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Phuc Le
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Cappelletti AM, Valenzuela Montero A, Cercato C, Duque Ossman JJ, Fletcher Vasquez PE, García García JE, Mancillas-Adame LG, Manrique HA, Ranchos Monterroso FDM, Segarra P, Navas T. Consensus on pharmacological treatment of obesity in Latin America. Obes Rev 2024; 25:e13683. [PMID: 38123524 DOI: 10.1111/obr.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
A panel of 10 experts in obesity from various Latin American countries held a Zoom meeting intending to reach a consensus on the use of anti-obesity medicines and make updated recommendations suitable for the Latin American population based on the available evidence. A questionnaire with 16 questions was developed using the Patient, Intervention, Comparison, Outcome (Result) methodology, which was iterated according to the modified Delphi methodology, and a consensus was reached with 80% or higher agreement. Failure to reach a consensus led to a second round of analysis with a rephrased question and the same rules for agreement. The recommendations were drafted based on the guidelines of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. This panel of experts recommends drug therapy in patients with a body mass index of ≥30 or ≥27 kg/m2 plus at least one comorbidity, when lifestyle changes are not enough to achieve the weight loss objective; alternatively, lifestyle changes could be maintained while considering individual parameters. Algorithms for the use of long-term medications are suggested based on drugs that increase or decrease body weight, results, contraindications, and medications that are not recommended. The authors concluded that anti-obesity treatments should be individualized and multidisciplinary.
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Affiliation(s)
- Ana María Cappelletti
- Favaloro University, Buenos Aires, Argentina
- Argentine Society of Nutrition, Buenos Aires, Argentina
| | | | - Cintia Cercato
- Endocrinology and Metabology Service, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | - Pablo Segarra
- Ecuadorian Society of Endocrinology, Quito, Ecuador
- Ecuadorian Society of Internal Medicine, Quito, Ecuador
| | - Trina Navas
- General Hospital "Dr. José Gregorio Hernandez", Los Magallanes, Caracas, Venezuela
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Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early- and later-stage persistence with antiobesity medications: A retrospective cohort study. Obesity (Silver Spring) 2024; 32:486-493. [PMID: 38053443 DOI: 10.1002/oby.23952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The study's objective was to examine the percentage of patients with an initial antiobesity medication (AOM) fill who were persistent with AOM at 3, 6, and 12 months and to characterize factors associated with persistence at 12 months. METHODS This retrospective cohort study used electronic health records from January 2015 to July 2023 in a large health system in Ohio and Florida and included adults with BMI ≥30 kg/m2 who had an initial AOM prescription filled between 2015 and 2022. RESULTS The authors identified 1911 patients with a median baseline BMI of 38 (IQR, 34-44). Over time, 44% were persistent with AOM at 3 months, 33% at 6 months, and 19% at 12 months. Across categories of AOM, the highest 1-year persistence was in patients receiving semaglutide (40%). Semaglutide (adjusted odds ratio [AOR] = 4.26, 95% CI: 3.04-6.05) was associated with higher odds of 1-year persistence, and naltrexone-bupropion (AOR = 0.68, 95% CI: 0.46-1.00) was associated with lower odds, compared with phentermine-topiramate. Among patients who were persistent at 6 months, a 1% increase in weight loss at 6 months was associated with 6% increased odds of persistence at year 1 (AOR = 1.06, 95% CI: 1.03-1.09). CONCLUSIONS Later-stage persistence with AOM varies considerably based on the drug and the weight loss at 6 months.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Pfoh
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Rebecca Schulte
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Phuc Le
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Mentias A, Desai MY, Aminian A, Patel KV, Keshvani N, Verma S, Cho L, Jacob M, Alvarez P, Lincoff AM, Van Spall HGC, Lam CSP, Butler J, Nissen SE, Pandey A. Trends and Outcomes Associated With Bariatric Surgery and Pharmacotherapies With Weight Loss Effects Among Patients With Heart Failure and Obesity. Circ Heart Fail 2024; 17:e010453. [PMID: 38275114 DOI: 10.1161/circheartfailure.122.010453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/28/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Utilization patterns of bariatric surgery among older patients with heart failure (HF), and the associations with cardiovascular outcomes, are not well known. METHODS Medicare beneficiaries with HF and at least class II obesity from 2013 to 2020 were identified with Medicare Provider Analysis and Review 100% inpatient files and Medicare 5% outpatient files. Patients who underwent bariatric surgery were matched to controls in a 1:2 ratio (matched on exact age, sex, race, body mass index, HF encounter year, and HF hospitalization rate pre-surgery/matched period). In an exploratory analysis, patients prescribed pharmacotherapies with weight loss effects (semaglutide, liraglutide, naltrexone-bupropion, or orlistat) were identified and matched to controls with a similar strategy in addition to HF medical therapy data. Cox models evaluated associations between weight loss therapies (as a time-varying covariate) and mortality risk and HF hospitalization rate (calculated as the rate of HF hospitalizations following index HF encounter per 100 person-months) during follow-up. RESULTS Of 298 101 patients with HF and body mass index ≥35 kg/m2, 2594 (0.9%) underwent bariatric surgery (45% men; mean age, 56.2 years; mean body mass index, 51.5 kg/m2). In propensity-matched analyses over a median follow-up of 4.7 years, bariatric surgery was associated with lower risk of all-cause mortality (HR, 0.55 [95% CI, 0.49-0.63]; P<0.001), greater reduction in HF hospitalization rate (rate ratio, 0.72 [95% CI, 0.67-0.77]; P<0.001), and lower atrial fibrillation risk (HR, 0.78 [95% CI, 0.65-0.93]; P=0.006). Use of pharmacotherapies with weight loss effects was low (4.8%), with 96.3% prescribed GLP-1 (glucagon-like peptide-1) agonists (semaglutide, 23.6%; liraglutide, 72.7%). In propensity-matched analysis over a median follow-up of 2.8 years, patients receiving pharmacotherapies with weight loss effects (versus matched controls) had a lower risk of all-cause mortality (HR, 0.82 [95% CI, 0.71-0.95]; P=0.007) and HF hospitalization rate (rate ratio, 0.87 [95% CI, 0.77-0.99]; P=0.04). CONCLUSIONS Bariatric surgery and pharmacotherapies with weight loss effects are associated with a lower risk of adverse outcomes among older patients with HF and obesity; however, overall utilization remains low.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Milind Y Desai
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, OH (A.A.)
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P.)
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., A.P.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, ON, Canada (S.V.)
| | - Leslie Cho
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Miriam Jacob
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Paulino Alvarez
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - A Michael Lincoff
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Harriette G C Van Spall
- Population Health Research Institute, Hamilton, ON, Canada (H.G.C.V.S.)
- McMaster University, Hamilton, ON, Canada (H.G.C.V.S.)
- Baim Institute for Clinical Research, Boston, MA (H.G.C.V.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- Department of Medicine, University of Mississippi School of Medicine, Jackson (J.B.)
| | - Steven E Nissen
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.M., M.Y.D., L.C., M.J., P.A., A.M.L., S.E.N.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.K., A.P.)
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D'Ascanio AM, Mullally JA, Frishman WH. Cagrilintide: A Long-Acting Amylin Analog for the Treatment of Obesity. Cardiol Rev 2024; 32:83-90. [PMID: 36883831 DOI: 10.1097/crd.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Despite the worldwide epidemic of obesity, there remain few approved pharmacological treatment options to bridge the gap between lifestyle therapy and bariatric surgery. Cagrilintide is an amylin-analog, now being developed in combination with the GLP-1 agonist semaglutide to achieve sustained weight loss in persons with overweight and obesity. Amylin, released with insulin from beta cells in the pancreas, induces its satiating effect via both the homoeostatic and hedonic regions of the brain. Semaglutide, a GLP-1 receptor agonist, reduces appetite via GLP-1 receptors in the hypothalamus and increases the production of insulin, and reduces glucagon secretion, delaying gastric emptying. These separate, but related mechanisms of action of an amylin-analog and a GLP-1 receptor agonist appear to have an additive effect on appetite reduction. Given the heterogeneity and complex pathogenesis of obesity, combination therapy with multiple pathophysiological targets is a logical approach to increasing weight loss response with pharmacotherapy. Cagrilintide alone, as well as cagrilintide in combination with semaglutide have shown promising weight loss in clinical trials that supports the further development of this therapy for sustained weight management.
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Affiliation(s)
| | - Jamie A Mullally
- Department of Medicine, Division of Endocrinology, New York Medical College/Westchester Medical Center, Valhalla, NY
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Galindo RJ, Uppal T, McCoy RG, Umpierrez GE, Ali MK. Use and continuity of weight-modifying medications among adults with diabetes and overweight/obesity: US population study. Obesity (Silver Spring) 2023; 31:2924-2935. [PMID: 37919239 PMCID: PMC10840906 DOI: 10.1002/oby.23869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Trends in use and continuity of use of diabetes-specific and non-diabetes weight-reducing (WR), weight-inducing (WI), and weight-neutral (WN) medications were examined among US adults with diabetes and overweight/obesity. METHODS Serial cross-sectional data from Medical Expenditure Panel Surveys (2010-2019) for adults (≥18 years) with diabetes and BMI ≥27 kg/m2 (≥25 kg/m2 for Asians) were analyzed. RESULTS Among 7402 US adults with diabetes and overweight/obesity (mean age 60.0 years [SD 13], 50% female), 64.9% of participants used any WI medications, decreasing from 68.9% (95% CI: 64.3%-73.5%) in 2010 to 58.6% (95% CI: 54.7%-62.5%) in 2019. It was estimated that 13.5% used WR medications, increasing 3.31-fold, from 6.4% (95% CI: 4.1%-8.7%) to 21.2% (95% CI: 18.0%-24.4%) and that 73.1% used WN medications, ranging from 70.5% (95% CI: 66.5-74.6) to 75.0% (95% CI: 71.7%-78.4%). Among adults using diabetes-specific WI (53.7%), WR (7.1%), and WN (62.4%) medications during the first year, 7.3%, 16.4%, and 9.0% discontinued it in the second year, respectively. CONCLUSIONS Over 2010-2019, 64.9% of adults with diabetes and overweight/obesity were treated with WI medications, 13.5% with WR medications, and 73.1% with WN medications. Discontinuation of WR medications was nearly twice that of WI medications.
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Affiliation(s)
- Rodolfo J. Galindo
- Emory University School of Medicine, Division of Endocrinology, Grady Memorial Hospital, 69 Jesse Hill Jr. Dr., Atlanta, GA, 30303
| | - Teg Uppal
- Emory University Rollins School of Public Health, Hubert Department of Global Health, 1518 Clifton Road NE, Atlanta, GA 30322
| | - Rozalina G. McCoy
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Guillermo E. Umpierrez
- Emory University School of Medicine, Division of Endocrinology, Grady Memorial Hospital, 69 Jesse Hill Jr. Dr., Atlanta, GA, 30303
| | - Mohammed K. Ali
- Emory University Rollins School of Public Health, Hubert Department of Global Health, 1518 Clifton Road NE, Atlanta, GA 30322
- Emory University School of Medicine, Department of Family and Preventive Medicine, 1518 Clifton Road NE, Atlanta, GA 30322
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11
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Ezeh E, Ilonze O, Perdoncin M, Ramalingam A, Kaur G, Mustafa B, Teka S, Ferdinand KC. Life's essential eight as targets for cardiometabolic risk reduction among non-Hispanic black adults: A primary care approach. J Natl Med Assoc 2023:S0027-9684(23)00143-8. [PMID: 38142141 DOI: 10.1016/j.jnma.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Cardiovascular diseases remain the leading cause of death in the United States. Several studies have shown racial disparities in the cardiovascular outcomes. When compared to their Non-Hispanic White (NHW) counterparts, non-Hispanic Black (NHB) individuals have higher prevalence of cardiovascular risk factors and thus, increased mortality from atherosclerotic cardiovascular diseases. This is evidenced by lower scoring in the indices of the American Heart Association's Life Essential 8 among NHB individuals. NHB individuals score lower in blood pressure, blood lipids, nicotine exposure, sleep, physical activity level, glycemic control, weight, and diet when compared to NHW individuals. Measures to improve these indices at the primary care level may potentially hold the key in mitigating the health care disparities in cardiovascular health experienced by NHB individuals.
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Affiliation(s)
- Ebubechukwu Ezeh
- Department of Medicine, Marshall University, Huntington, WV, United States.
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis
| | - Maddie Perdoncin
- Department of Medicine, Marshall University, Huntington, WV, United States
| | - Archana Ramalingam
- Department of Medicine, Marshall University, Huntington, WV, United States
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Bisher Mustafa
- Department of Medicine, Marshall University, Huntington, WV, United States
| | - Samson Teka
- Department of Medicine, Marshall University, Huntington, WV, United States
| | - Keith C Ferdinand
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States
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12
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Du L, Lü H, Chen Y, Yu X, Jian T, Zhao H, Wu W, Ding X, Chen J, Li W. Blueberry and Blackberry Anthocyanins Ameliorate Metabolic Syndrome by Modulating Gut Microbiota and Short-Chain Fatty Acids Metabolism in High-Fat Diet-Fed C57BL/6J Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:14649-14665. [PMID: 37755883 DOI: 10.1021/acs.jafc.3c04606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
In this study, blueberry (Vaccinium ssp.) anthocyanins (VA) and blackberry (Rubus L.) anthocyanins (RA) were used to investigate the effects on metabolic syndrome (MetS) and the potential mechanisms. Importantly, all of the data presented in this study were obtained from experiments conducted on mice. As a result, VA and RA reduced body weight gain and fat accumulation while improving liver damage, inflammation, glucose, and lipid metabolism induced by a high-fat diet. Moreover, VA and RA regulated the gut microbiota composition, decreasing the pro-obesity and proinflammation bacteria taxa, such as the phylum Actinobacterium and the genera Allobaculum and Bifidobacterium, and increasing those negatively associated with obesity and inflammation, such as the phylum Bacteroidetes and the genera Prevotella and Oscillospira. Additionally, the supplementation with VA and RA reversed the elevated levels of valeric, caproic, and isovaleric acids observed in the high-fat diet (HFD) group, bringing them closer to the levels observed in the Chow group. This reversal indicated that alterations in the composition and abundance of gut microbiota may contribute to the restoration of short-chain fatty acids (SCFAs) levels. Additionally, PICRUSt2 exhibited that cyanamino acid metabolism and betalain biosynthesis might be the major metabolic pathways in the HVA group compared with the HFD group, while in the HRA group, it was the phosphotransferase system. These findings suggest that VA and RA can ameliorate MetS by modulating the gut microbiota and production of SCFAs.
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Affiliation(s)
- Lanlan Du
- Co-Innovation Center for Sustainable Forestry in Southern China, College of Forestry, Nanjing Forestry University, Nanjing 210037, China
| | - Han Lü
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Yan Chen
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Xiaohua Yu
- Jiangsu Zhongzhi Ecological Plant Research Institute Co., Ltd., Nanjing 211200, China
| | - Tunyu Jian
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Huifang Zhao
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Wenlong Wu
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Xiaoqin Ding
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Jian Chen
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China
| | - Weilin Li
- Co-Innovation Center for Sustainable Forestry in Southern China, College of Forestry, Nanjing Forestry University, Nanjing 210037, China
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13
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Almazan E, Schwartz JL, Gudzune KA. Use of medications associated with weight change among participants in the All of Us research programme. Clin Obes 2023; 13:e12609. [PMID: 37455380 PMCID: PMC10528729 DOI: 10.1111/cob.12609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Our objective was to describe the use of medications associated with weight change among US adults with overweight/obesity, including anti-obesity medications (AOMs), weight-loss-promoting and weight-gain-promoting medications. We performed a cross-sectional analysis of data from the nationwide All of Us Research Programme. We included adults with measured body mass index (BMI) ≥ 27 kg/m2 enrolled between 2018 and 2022 across the United States. We used linked electronic health record data to determine medication use ±12 months of BMI measure. Our 132 057 participants had mean age 54 years and mean BMI 34 kg/m2 ; 60% of participants were women, 62% White, and 32% Black. Only 1% used any AOM, and 14% used at least one weight-loss-promoting medication. We found that 36% used at least one weight-gain-promoting medication, and approximately 20% used multiple weight-gain-promoting medications. While AOMs are underutilized by participants with overweight/obesity, weight-gain-promoting medication use is common. Our results raise concern about potential iatrogenic weight gain from medications. Future research is needed to estimate the long-term effect of weight-gain-promoting medications on weight status and determine whether weight-loss benefits occur with their discontinuation. Clinician education on AOMs and weight-loss-promoting medications may be needed to increase their use.
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Affiliation(s)
- Erik Almazan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kimberly A. Gudzune
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
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14
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Choi YJ, Choi CY, Kim CU, Shin S. A nationwide pharmacovigilance investigation on trends and seriousness of adverse events induced by anti-obesity medication. J Glob Health 2023; 13:04095. [PMID: 37651636 PMCID: PMC10471157 DOI: 10.7189/jogh.13.04095] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Introduction Despite rising concerns regarding the safety of anti-obesity medications, there is a lack of comprehensive pharmacovigilance investigations utilising real-world data. We aimed to characterise the prevalence and seriousness of adverse drug events (ADEs) related to anti-obesity medications and to identify predictors associated with increased risk of serious adverse events (SAE), thereby conveying evidence on drug safety. Methods We conducted a cross-sectional analysis on ADE cases spontaneously reported to the Korea Adverse Event Reporting System Database (KIDS-KD). ADE reports pertaining to anti-obesity medications prescribed for overweight, obesity (International Classification of Disease, 10th revision (ICD-10) code E66) and abnormal weight gain (ICD-10 code E63.5) were included in the analysis. We performed a disproportionality to detect the association of the system organ class-based ADEs with their seriousness an individual's sex by estimating reporting odds ratios (RORs) and their 95% confidence intervals (CIs). We performed logistic regression to investigate factors that are substantially associated with increased SAE risks by estimating odds ratio (OR) and their 95% CIs. Results The most common causative anti-obesity medication was phentermine, followed by liraglutide. ADEs associated with psychiatric disorders (ROR = 1.734; 95% CI = 1.111-2.707), liver and biliary system disorders (ROR = 22.948; 95% CI = 6.613-70.635), cardiovascular disorders (ROR = 5.707; 95% CI = 1.965-16.574), and respiratory disorders (ROR = 4.567; 95% CI = 1.774-11.762) were more likely to be serious events. Additionally, men are more likely to experience ADEs related gastrointestinal disorders (ROR = 1.411) and less likely to have heart and rhythm disorders (ROR = 0.507). The risk of SAE incidences was positively correlated with being male (OR = 2.196; 95% CI = 1.296-3.721), dual or triple combination of anti-obesity medications (OR = 3.258; 95% CI = 1.633-6.501 and OR = 8.226; 95% CI = 3.046-22.218, respectively), and concomitant administration of fluoxetine (OR = 5.236; 95% CI = 2.218-12.365). Conclusions Seriousness of anti-obesity medication-related ADEs differs among system-organ class, while sex-related differences in ADE profiles are also present. The predictors substantially increasing risk of SAE incidences include being male, having a higher number of concomitant medications (including multiple combination of anti-obesity medications), and concurrent use of fluoxetine. Nonetheless, further pharmacovigilance investigation and monitoring are needed to enhance awareness on ADEs induced by anti-obesity medications.
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Affiliation(s)
- Yeo Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, South Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, South Korea
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, South Korea
| | - Chang-Young Choi
- Department of Internal Medicine, Ajou University Medical Hospital, Suwon, South Korea
| | - Choong Ui Kim
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, South Korea
| | - Sooyoung Shin
- Department of Pharmacy, College of Pharmacy, Ajou University, Suwon, South Korea
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, South Korea
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15
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Hall KF, Korona-Bailey J, Mukhopadhyay S. Phentermine involvement in fatal drug overdoses in Tennessee, 2019-2022. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104151. [PMID: 37549596 DOI: 10.1016/j.drugpo.2023.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Phentermine, one of the most-commonly prescribed pharmaceuticals for weight-loss in the United States (US), has appeared on toxicology and listed as a cause of death in fatal drug overdoses in the state of Tennessee. This study aims to evaluate phentermine's involvement in fatal drug overdoses in the state of Tennessee. METHODS We used Tennessee State Unintentional Drug Overdose Reporting System (SUDORS) data and controlled substances monitoring program data (CSMD) to evaluate demographics, prescription history and co-occurring substances on toxicology in phentermine-positive cases compared with all other SUDORS cases from January 1, 2019 to June 30, 2022. A subset of these cases which listed phentermine as a cause of death was also assessed. RESULTS We identified 51 phentermine-positive cases, with a subset of 20 that listed phentermine as a cause of death. When compared to all SUDORS cases, a higher proportion of cases that listed phentermine as a cause of death were White race, females, and aged 35-44. Additionally, in all phentermine-positive cases, 41% (21) of decedents had not had a phentermine prescription dating back to 2012 and 20% (Lee et al., 1998) did not have one within the last 30 days. While there was a slight decline each year in the number of phentermine-positive cases, the number of cases that listed phentermine as a cause of death remained relatively consistent, with 95% (19) of cases having different prescriptions and/or illicit drugs listed as a cause of death along with phentermine. CONCLUSION Phentermine was listed as a cause of death in 20 fatal drug overdoses in TN. Our findings suggest there may be differences in the characteristics of these decedents when compared to all SUDORS decedents, including distribution of age, gender, and race. We also found a large presence of other prescription and illicit drugs in toxicology and cause of death along with phentermine, as well as evidence of use of the drug without a prescription. Given the lack of currently available data about non-prescribed phentermine use and its involvement in fatal drug overdoses elsewhere, a need exists to both expand surveillance capabilities and broaden research to better inform policies governing this drug in the US and internationally.
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Affiliation(s)
- Kristi F Hall
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
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16
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Weintraub MA, D’Angelo D, Tchang BG, Sahagun AD, Andre C, Aronne LJ, Shukla AP. Five-year Weight Loss Maintenance With Obesity Pharmacotherapy. J Clin Endocrinol Metab 2023; 108:e832-e841. [PMID: 36810608 PMCID: PMC10438886 DOI: 10.1210/clinem/dgad100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals because of several factors including adherence and metabolic adaptation. Medical management of obesity has proven efficacy for up to 3 years in randomized controlled trials. However, there is a dearth of information regarding real-world outcomes beyond 3 years. OBJECTIVE This work aimed to assess long-term weight loss outcomes over a 2.5- to 5.5-year period with US Food and Drug Administration (FDA)-approved and off-label antiobesity medications (AOMs). METHODS A cohort of 428 patients with overweight or obesity were treated with AOMs at an academic weight management center with an initial visit between April 1, 2014, and April 1, 2016. Intervention included FDA-approved and off-label AOMs. The primary outcome was percentage weight loss from initial to final visit. Key secondary outcomes included weight reduction targets as well as demographic and clinical predictors of long-term weight loss. RESULTS The average weight loss was 10.4% at a mean follow-up duration of 4.4 years. The proportions of patients who met the weight reduction targets of 5% or greater, 10% or greater, 15% or greater, and 20% or greater were 70.8%, 48.1%, 29.9%, and 17.1%, respectively. On average, 51% of maximum weight loss was regained, while 40.2% of patients maintained their weight loss. In a multivariable regression analysis, a higher number of clinic visits was associated with more weight loss. Metformin, topiramate, and bupropion were associated with increased odds of maintaining 10% or greater weight loss. CONCLUSION Clinically significant long-term weight loss of 10% or more beyond 4 years is achievable in clinical practice settings with obesity pharmacotherapy.
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Affiliation(s)
- Michael A Weintraub
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10021, USA
| | - Debra D’Angelo
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10021, USA
| | - Beverly G Tchang
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ageline D Sahagun
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10021, USA
| | - Clarissa Andre
- Department of Internal Medicine, New York Presbyterian Hospital–Weill Cornell, New York, NY 10021, USA
| | - Louis J Aronne
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10021, USA
| | - Alpana P Shukla
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10021, USA
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17
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Murvelashvili N, Xie L, Schellinger JN, Mathew MS, Marroquin EM, Lingvay I, Messiah SE, Almandoz JP. Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence. Obesity (Silver Spring) 2023; 31:1280-1289. [PMID: 36998152 DOI: 10.1002/oby.23736] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery (MBS) weight recurrence. METHODS A retrospective analysis of 207 adults with post-MBS weight recurrence treated with semaglutide 1.0 mg weekly (n = 115) or liraglutide 3.0 mg daily (n = 92) at an academic center from January 1, 2015, through April 1, 2021, was conducted. The primary end point was percentage body weight change at 12 months of treatment with regimens containing semaglutide or liraglutide. RESULTS The mean sample age was 55.2 years; mean BMI was 40.4 kg/m2 ; 89.9% were female; and 50% completed sleeve gastrectomy, 29% completed Roux-en-Y gastric bypass, and 21% completed adjustable gastric banding. Least-squares mean weight change at 12 months was -12.92% versus -8.77% in the semaglutide and liraglutide groups, respectively (p < 0.001). The adjusted odds ratios were 2.34 (95% CI: 1.28-4.29) for ≥10% weight loss and 2.55 (95% CI: 1.22-5.36) for ≥15% weight loss over 12 months in the semaglutide group versus liraglutide group, respectively. Weight-loss efficacy of semaglutide (vs. liraglutide) did not differ by subgroups explored, including age, sex, and MBS procedure. CONCLUSIONS These results show that treatment regimens including semaglutide 1.0 mg weekly lead to superior weight loss compared with liraglutide 3.0 mg daily for treating post-MBS weight recurrence, regardless of procedure type or the magnitude of weight recurrence.
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Affiliation(s)
- Natia Murvelashvili
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Ildiko Lingvay
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
- Department of Pediatrics, John P. and Kathrine G. McGovern School of Medicine at UTHealth, Houston, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
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18
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Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, Harindhanavudhi T, Sultan S, Singh S, Davitkov P. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology 2022; 163:1198-1225. [PMID: 36273831 DOI: 10.1053/j.gastro.2022.08.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND & AIMS Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis of the following agents: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision framework to develop recommendations for the pharmacological management of obesity and provided implementation considerations for clinical practice. RESULTS The guideline panel made 9 recommendations. The panel strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with weight-related complications) who have an inadequate response to lifestyle interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap. CONCLUSIONS In adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.
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Affiliation(s)
- Eduardo Grunvald
- Department of Medicine, University of California San Diego, La Jolla, California.
| | - Raj Shah
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Hernaez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Octavia Pickett-Blakely
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Bhardwaj NJ, Chae K, Sheng JY, Yeh HC. Clinical interventions to break the obesity and cancer link: a narrative review. Cancer Metastasis Rev 2022; 41:719-735. [PMID: 35933566 DOI: 10.1007/s10555-022-10055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
Excess body weight is a significant risk factor for the development and recurrence of many types of cancer. Patients with a history or current diagnosis of cancer who are overweight or have obesity have an increased risk of cancer treatment-related morbidity, recurrence, and decreased quality of life. Weight loss and maintenance of a healthy body weight may reduce cancer morbidity and recurrence in cancer survivors. While guidelines for cancer survivorship elaborate sufficiently on lifestyle interventions, little guidance is provided when considering additional therapies like anti-obesity pharmacotherapy or bariatric surgery for weight loss. This review will highlight and address current recommendations and feasible interventions that clinicians may consider to further reduce the incidence and recurrence of cancer in patients with obesity.
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Affiliation(s)
- Nakul J Bhardwaj
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kacey Chae
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Truong GTD, Creech ZA, Narechania S, Malesker MA. Multiorgan Failure After Phentermine Overdose. J Pharm Technol 2022; 38:191-192. [PMID: 35600281 PMCID: PMC9116121 DOI: 10.1177/87551225221088980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Shraddha Narechania
- Department of Pulmonary, Critical Care, and
Sleep Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Mark A. Malesker
- School of Pharmacy and Health Professions,
Creighton University, Omaha, NE, USA
- Mark A. Malesker, Professor of Pharmacy Practice,
School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza,
Omaha, 68178 NE, USA.
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Molecular Imaging of Central Dopamine in Obesity: A Qualitative Review across Substrates and Radiotracers. Brain Sci 2022; 12:brainsci12040486. [PMID: 35448017 PMCID: PMC9031606 DOI: 10.3390/brainsci12040486] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Dopamine is a neurotransmitter that plays a crucial role in adaptive behavior. A wealth of studies suggests obesity-related alterations in the central dopamine system. The most direct evidence for such differences in humans comes from molecular neuroimaging studies using positron emission tomography (PET) and single-photon emission computed tomography (SPECT). The aim of the current review is to give a comprehensive overview of molecular neuroimaging studies that investigated the relation between BMI or weight status and any dopamine target in the striatal and midbrain regions of the human brain. A structured literature search was performed and a summary of the extracted findings are presented for each of the four available domains: (1) D2/D3 receptors, (2) dopamine release, (3) dopamine synthesis, and (4) dopamine transporters. Recent proposals of a nonlinear relationship between severity of obesity and dopamine imbalances are described while integrating findings within and across domains, after which limitations of the review are discussed. We conclude that despite many observed associations between obesity and substrates of the dopamine system in humans, it is unlikely that obesity can be traced back to a single dopaminergic cause or consequence. For effective personalized prevention and treatment of obesity, it will be crucial to identify possible dopamine (and non-dopamine) profiles and their functional characteristics.
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Attitudes, Perceptions, and Practices in Managing Obesity Among Endocrinologists. Endocr Pract 2021; 28:179-184. [PMID: 34748965 DOI: 10.1016/j.eprac.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Obesity is globally recognized as a critically important disease by professional medical organizations in addition to the World Health Organization and American Medical Association, but the health care systems, medical teams, and the public have been slow to embrace this concept. METHODS American Association of Clinical Endocrinology (AACE) staff drafted the survey, and two endocrinologists independently reviewed the survey questions and modified the survey instrument. The survey included inquiries related to practice and patient demographics, awareness of obesity, treatment of obesity, barriers to improving obesity outcomes, digital health, cognitive behavioral therapy, lifestyle medicine, anti-obesity medications, weight stigma, and social determinants of health. The survey was emailed to 493 endocrinologists, with 305 completing the study (62%). RESULTS Ninety-eight percent of the responders agree that obesity is a disease, while 2% neither agree nor disagree. 53% of respondents are familiar with the term "adiposity-based chronic disease." 13% of the respondents are certified by the American Board of Obesity Medicine (ABOM). 57% of the respondents use published obesity guidelines as a resource for treating patients with obesity. Most endocrinologists recommend dietary and lifestyle changes, but fewer prescribe anti-obesity medication (AOM) or recommend bariatric surgery. ABOM-certified endocrinologists are more likely to use a multidisciplinary approach. CONCLUSION Self-reported knowledge and practices in the management of obesity highlight the importance of a multimodal approach to obesity and foster collaboration among healthcare professionals. It is necessary to raise awareness about obesity among clinicians, identify knowledge gaps and create educational tools to address those gaps.
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Bini J, Norcross M, Cheung M, Duffy A. The Role of Positron Emission Tomography in Bariatric Surgery Research: a Review. Obes Surg 2021; 31:4592-4606. [PMID: 34304378 DOI: 10.1007/s11695-021-05576-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Bariatric surgery, initially understood as restricting or bypassing the amount of food that reaches the stomach to reduce food intake and/or increase malabsorption of food to promote weight loss, is now recognized to also affect incretin signaling in the gut and promote improvements in system-wide metabolism. Positron emission tomography (PET) is an imaging technique whereby patients are injected with picomolar concentrations of radioactive molecules, below the threshold of having physiological effects, to measure spatial distributions of blood flow, metabolism, receptor, and enzyme pharmacology. Recent advances in both whole-body PET imaging and radioligand development will allow for novel research that may help clarify the roles of peripheral and central receptor/enzyme systems in treating obesity with bariatric surgery.
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Affiliation(s)
- Jason Bini
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 801 Howard Avenue, PO Box 208048, New Haven, CT, USA.
| | | | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Duffy
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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